Drug Reference

Acute Myeloid Leukemia (AML): Stem Cell Transplant

What is a stem cell transplant?

Stem cells are immature cells that are the starter cells for all types of body tissues. A stem cell transplant uses stem cells to replace bone marrow that contains cancer. These stem cells will grow and become new and healthy bone marrow. The bone marrow with cancer is first destroyed with high-dose chemotherapy. Or, this may be done with radiation to the whole body. Healthy stem cells are then put in your body.

When might a stem cell transplant be used for AML?

A doctor may advise a stem cell transplant in cases like these:

Your leukemia is in remission after induction therapy.

Your leukemia doesn’t go away completely with induction chemotherapy.

Your leukemia returns after a period of remission.

You are younger and healthy enough to tolerate it.

Types of stem cell transplants

There are 2 kinds of stem cell transplants:

Allogeneic transplant. This means the stem cells come from another person whose cell type is almost exactly like yours. This may be a brother or sister.

Autologous transplant. This means the stem cells are collected from your own body and preserved. This is done before you get chemotherapy.

Doctors often prefer to do an allogeneic transplant if a stem cell donor can be found. Doctors might do an autologous transplant if it's hard to find an exact match from a donor. It may cause fewer side effects, but there is also concern that the stem cells from your own body could have some leukemia cells, even after treatment in a lab. Discuss the risks and benefits with your doctor. It's often best to wait for an induced remission and for the chemotherapy side effects to wear off before having a transplant, if possible.

How stem cells are collected

From the blood. This is the most common source of stem cells for a transplant. You or your donor may get an injection of a growth factor medicine for several days. This medicine helps stimulate stem-cell production. The process for collecting stem cells from the blood is called apheresis. It’s a lot like giving blood, but it takes longer. A thin, flexible tube (catheter) is used to get blood from your vein or from a donor. The blood goes to a cell separation device to remove the stem cells. The stem cells are then frozen until needed later. Then the extra blood is returned to you or the donor. You may have a strange taste in your mouth during the process. This is from the preservative used to freeze the stem cells. This process may need to be done more than once to collect the right amount of cells.

From the bone marrow. Stem cells may also be taken from the bone marrow of you or the donor. This process is done while you or your donor is asleep with general anesthesia. A doctor makes several punctures in the pelvic or hip bone to remove marrow. Soreness in the hip bone may last for several days. These stem cells are filtered and frozen until they are needed.

Having the transplant

You will be admitted to the hospital the day before your transplant. Your doctor or nurse will go over how to keep your gown sterile, how to prepare your food after the transplant, and other ways to help you avoid germs. This is needed to lower your exposure to infections.

After the chemotherapy or radiation therapy is finished, you will receive the stored stem cells through a needle in your arm that’s attached to a tube. This is similar to a blood transfusion.

You will then have to wait for your stem cells to start multiplying. You may have to stay in isolation away from people to avoid getting an infection. Once the part of your white blood cell count (absolute neutrophil count) reaches a safe level, you can come out of isolation and then eventually go home. This may happen within several weeks, or it may take longer.

You will need to have your blood drawn often to check your blood cell count for the next several weeks. This can be done on an outpatient basis.

What is a mini-transplant?

A mini-transplant is sometimes used for a person with AML who can’t tolerate a standard stem cell transplant. It’s also called nonmyeloablative transplant. The treatment is done with a lower dose of chemotherapy or radiation. This doesn't fully destroy the cells in the bone marrow. But it’s enough to suppress the immune system. Then you receive donor stem cells. These stem cells later develop an immune reaction to the leukemia cells and kill them.

Because this treatment uses lower doses of chemotherapy or radiation, it often has less severe side effects. Older adults or people with other health problems can often tolerate this treatment better.

Possible short-term side effects

Most of the short-term side effects of a stem cell transplant are from the high doses of chemotherapy or radiation. These should go away as you recover from the transplant. Common side effects can include:

Infections

Low blood cell counts

Bleeding

Low blood pressure

Shortness of breath

Chest pain or tightness

Coughing

Fever or chills

Hair loss

Nausea

Vomiting

Mouth sores

Loss of appetite

Diarrhea

Tiredness

Weakness

Possible long-term side effects

Some side effects of a stem cell transplant may be long-lasting or appear years later, such as:

Bone pain, caused from damage due to lack of blood supply (aseptic necrosis)

Growth of another cancer

Shortness of breath, often caused by radiation damage to the lungs

Damage to the liver, kidneys, or other organs

Lack of menstrual periods, which may mean ovary damage and cause infertility

Vision problems caused by damage to the lens of the eye

Weight gain, which may be a sign of thyroid gland damage

Another possible long-term side effect is graft-versus-host disease. This can only occur with an allogeneic transplant. The immune system cells in the donor's stem cells attack your body. The cells can attack your skin, liver, gastrointestinal tract, mouth, or other organs. This can cause symptoms such as:

Skin rashes with itching

Yellowing of the skin (jaundice)

Severe diarrhea

Fatigue

Muscle aches

Making a decision

It's important to discuss the procedure with your doctor to make sure you understand the possible risks and benefits.

Stem cell transplant is a complex procedure. It’s only done by doctors with special training. If you decide to have one, go to a hospital that specializes in stem cell transplants, such as a major cancer center. The procedure is also expensive. It can cost more than $100,000. Make sure to check with your insurance provider to see how much of it will be covered.